Provider Demographics
NPI:1316092679
Name:MEYERHOFF, JESSAMYN (LFMT)
Entity type:Individual
Prefix:
First Name:JESSAMYN
Middle Name:
Last Name:MEYERHOFF
Suffix:
Gender:F
Credentials:LFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:LAGUNITAS
Mailing Address - State:CA
Mailing Address - Zip Code:94938-0234
Mailing Address - Country:US
Mailing Address - Phone:510-394-5173
Mailing Address - Fax:
Practice Address - Street 1:234 ARROYO RD
Practice Address - Street 2:
Practice Address - City:LAGUNITAS
Practice Address - State:CA
Practice Address - Zip Code:94938-1513
Practice Address - Country:US
Practice Address - Phone:510-393-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health